Dear Secretary McDonough,
We write to address the needs of Veterans who have experienced a traumatic brain injury (TBI). Specifically, as the Department of Veterans Affairs (VA) considers policy changes to Community Care established in the VA MISSION Act of 2018 (P.L. 115-182), we request that you review reported inconsistencies in Community Care policy decisions that may have resulted in unjust denials of community care for Veterans with a TBI.
Since 2001, millions of servicemembers have deployed to combat zones, and over half have deployed more than once. Estimates suggest that around half a million of these servicemembers returned home with a TBI. Approximately 50% of veterans with a history of TBI also meet the criteria for post-traumatic stress disorder (PTSD) and other complex comorbidities including cognitive impairment, pain disorders, substance misuse, and an elevated risk for suicidal ideation.
To address the challenging clinical needs associated with evaluating and treating invisible wounds, the Marcus Institute for Brain Health (MIBH) at the University of Colorado Anschutz Medical Campus established a pioneering civilian veteran brain health institute. Since 2017, the MIBH has successfully evaluated, educated, and supported nearly 400 veterans and their families. MIBH's interdisciplinary model of care is modeled after that of the National Intrepid Center of Excellence (NICoE), which evaluates and treats active-duty service members with TBI. After completing a course of treatment at the MIBH, every patient has reported some improvement in their overall health, function, and wellness. Approximately 75% demonstrate a clinically important reduction in the severity of their TBI-related symptoms.
The MIBH shares a strong partnership with the VA. They have an existing Memorandum of Agreement with the VA and all clinical providers are included in VA's Community Care Network.
It is our understanding that approximately 100 veterans enrolled in VHA care have requested treatment at the MIBH under one of the six VA Community Care eligibility criteria as outlined in the 2018 VA MISSION Act. Unfortunately, only 10% have been authorized to obtain this care for their persistent TBI symptoms. MIBH treats all of these veteran patients, regardless of their ability to pay, but it is disheartening to hear that veterans from across the country are being denied the top-quality care to which they are entitled under the VA MISSION Act.
Veterans with persistent TBI symptoms are at a higher risk of suicide, making access to specialized treatment essential. We urge the VA to promptly authorize community care for these high-risk Veterans under their existing eligibility criteria. It is critical for veterans to receive timely and appropriate care, and we look forward to working with you to ensure that they do.